Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4327
Country/Region: Rwanda
Year: 2007
Main Partner: Columbia University
Main Partner Program: Mailman School of Public Health
Organizational Type: University
Funding Agency: HHS/CDC
Total Funding: $4,600,000

Funding for Care: Adult Care and Support (HBHC): $0


This activity is related to activities in ARV services (2787 and 2736), basic health care (2811), SI (4985) and laboratory infrastructure (2734). Columbia will continue to provide basic clinical care services to 15,000 existing patients enrolled in care at 28 existing sites. Basic healthcare will include OI prophylaxis, diagnosis and treatment, counseling on positive living (including alcohol abuse prevention, nutrition counseling, malaria prevention, and HIV prevention). Columbia will assure the clinical management or referral of complicated cases to reference or district hospitals. Nurses at health facilities will be trained and mentored to stage all PLWHA reached through PMTCT, CT or PIT with informed consent. Through the EP OI procurement, Columbia will ensure that facilities in the target districts have a stock of drugs to treat OI, manage ART side effects and provide preventive treatment for medical staff exposed to suspected HIV-contaminated fluids and rape victims.

At the site level, linkages between clinical and community-based services will be assured through placement of social workers and community activities coordinators at health facilities. In cooperation with the CSP, these staff will enhance the quality of community-based care throughout the network by training HBC workers in adherence support and psychosocial counseling. The community activities coordinators will support CSP partners to monitor HBC workers through frequent field visits and joint supervision activities.

At the district level, a community services coordinator will ensure that all facilities are linked to community services providers and that community services such as food aid, social and economic support, and counseling and referrals for domestic violence and rape victims are available throughout the district. In collaboration with community services providers, Columbia will assist in the development of a standard nutritional package for patients enrolled in HIV care at sites. Guidelines for an appropriate minimum family package and a screening tool will be developed to help select recipients for nutritional support.

In collaboration with the Data Analysis and Use project (activity 4985), Columbia will strengthen the medical record system for each site and train DHTs to verify data reliability. In addition, Columbia will encourage and facilitate the use of routinely collected data for problem solving, quality improvement and program evaluation. This will include providing computer programs to sites for summary reports of their patient-level data and training in interpretation of data for program improvement. Columbia will also organize quarterly M&E workshops for staff from MCAP-supported sites to enhance the collection and use of data at the site-level.

These activities support the Rwanda EP five-year strategy goals for palliative care by rapidly expanding the availability of care services towards the USG goal of three health centers per district providing basic care, and by improving linkages between clinical and community care services in the network model.

Funding for Treatment: Adult Treatment (HTXS): $4,600,000

This activity relates to HTXS (7175), MTCT (7179), HBHC (7177), HVTB (7180), HVAB (8186), HVOP (8133), and OHPS (7218).

In FY 2006, Columbia is providing a comprehensive package of ART services at 35 sites serving 10,620 patients, including 1,076 children. The package includes treatment with ARV drugs, routine CD4 follow up, viral load testing for an estimated 800 eligible patients with decreased or stable CD4 after nine months of HAART, management of ARV drug side effects, and patient referrals to community-based care.

In FY 2007, Columbia will expand quality clinical services, continue support to the DHTs, increase sustainability through performance-based financing, and strengthen SI at all levels.

With procurement support from PFSCM, Columbia will provide ARV drugs, CD4 tests, and viral load tests to all supported sites. In order to ensure continuum of care, HIV case managers at sites will train and supervise community volunteers including CHWs, PLWHA association members, and other caretakers, in collaboration with CHAMP. Increasing pediatric patient enrollment is a major priority for all USG clinical partners in FY 2007. Case managers will ensure referrals of pediatric patients identified from PMTCT programs, PLWHA associations, and malnutrition centers. In addition, adult patients enrolled in care will be encouraged to have their children tested. To expand quality pediatric care, Rwanda's few available pediatricians will mentor other clinical providers, using the Columbia UTAP model developed in FY 2006.

In the context of decentralization, DHTs now play a critical role in the oversight and management of clinical and community service delivery. Columbia will strengthen the capacity of eight DHTs to coordinate an effective network of ARV and other HIV/AIDS services. The basic package of financial and technical support includes staff for oversight and implementation, transportation, communication, training of providers, and other support to carry out key responsibilities.

The Rwanda EP will continue a gradual shift in funding from input financing to performance-based financing. Through a strategic mix of input through the district support package and directly to health facilities, and output performance-based financing through the purchase of improved performance for specific HIV indicators, districts will receive the appropriate support to increase autonomy and sustainability.

In addition, Columbia will strengthen district and facility level capacity for data collection, reporting and use with focus on ARV drugs management, HIV case management, and improved quality implementation and program evaluation. Sites will generate routine summary reports of patient-level data and will interpret that data to inform their programmatic operations. Columbia will also organize periodic M&E workshops for all supported sites to discuss the collection and use of data at the site-level.

This activity supports the EP five-year strategy for national scale-up and sustainability and the Rwandan Government ART decentralization plan and addresses the key legislative issues of gender, stigma and discrimination.

Subpartners Total: $0
Treatment and Research AIDS Center: NA
National Reference Laboratory - Rwanda: NA